SiCKO Shows Reality of Medical Biller's World

With the release this Friday (June 29) of Michael Moore's "SiCKO", audiences will get to see firsthand the vagaries of the U.S. health insurance system. Those of us in the medical billing field, who do our level best to process and advocate for appropriate payment to the doctors we represent, see the games the insurance carriers play every day.

Depending upon the day of the week, it seems, the rules change. What was supposed to be represented in each field of the CMS1500 one day, is unacceptable the next, requiring resubmission after resubmission. The payers know all too well that a significant portion of these rejected claims will fall by the wayside eventually. Hence the point of Moore's documentary.

And of course, the payers will rely on "government regulations" as the reason for modifications, clarifications (obfuscations, in fact). The reality, as SiCKO reflects, is that the massive lobbying community has a chokehold on the leadership of this country. Those new regulations that are fomented in a dizzying fashion out of Washington are, of course, absurdly beneficial to the insurance companies, but lawyered in such a way as to appear either (a) legitimate, or (b) completely hidden from view altogether until a rejected claim comes our way, illustrating the new rule.

The "When did THAT happen?" feeling we often get tends to make one unsure of one's professional abilities from time to time. Not to mention the doctor's frustration that payments for services rendered are increasingly questioned.

For medical billing professionals, this is not a do or die mission, but hopefully with the light shed by SiCKO, perhaps some of the lobbyists will not be quite as bold in the future, and more importantly, health insurance plans will be more accountable to the patient and to the medical practices in this country.

Donald Roche
The Medical Billing Foundation
http://www.MedicalBillingFoundation.com